Procedure Codes for RPM in Pain Management
Before we list down procedure codes for RPM in pain management, let’s understand basics of Remote Patient Monitoring (RPM) in pain management and it’s reimbursement challenges.
Basics of Remote Patient Monitoring (RPM) in Pain Management
Remote Patient Monitoring (RPM) is a technology-enabled healthcare delivery approach that allows healthcare providers to remotely monitor patients’ health status in real-time through digital devices. RPM is increasingly being used in pain management to improve patient outcomes by providing clinicians with more accurate and timely data on patients’ pain levels and treatment responses.RPM for pain management typically involves patients wearing wearable sensors that track vital signs, activity levels, and other indicators of pain, such as facial expressions and vocalizations. This data is transmitted to healthcare providers who can use it to make more informed decisions about pain management treatments and adjustments.
Reimbursement Challenges for RPM in Pain Management
Remote Patient Monitoring (RPM) has become an increasingly popular way to manage patients with chronic pain. However, there are several insurance reimbursement challenges for RPM in pain management. One of the major challenges is the lack of specific reimbursement codes for RPM. Currently, most insurance companies do not have specific codes for RPM in pain management, which means that providers may not be reimbursed for the service. Another challenge is some insurance plans may have limited coverage for RPM in pain management, or they may only cover certain types of RPM devices. This can make it difficult for patients to access the technology they need to manage their pain effectively.It is important to note that the reimbursement rates for RPM services can vary widely depending on the insurance company and the specific policy. Let’s list down procedure codes for RPM in pain management.
Procedure Codes for RPM in Pain Management
As mentioned earlier, most insurance companies have limited number of procedure codes for RPM in pain management. The use of these codes for billing RPM in pain management may vary depending on the specific circumstances of the patient and the healthcare provider. The appropriate CPT code for RPM services may vary depending on the specific details of the service provided, and the payer’s policies and guidelines. It is recommended to consult with the payer for specific coding requirements and guidelines. The most commonly used CPT codes for billing RPM services in pain management include:
- CPT code 99091: This code is used for collection and interpretation of physiologic data (e.g., electrocardiogram, blood pressure, weight) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional for review. This code is typically used for remote monitoring of chronic conditions, including pain management.
- CPT code 99457: This code is used for remote evaluation and management services provided by a physician or other qualified healthcare professional to an established patient, for up to 20 minutes of clinical staff time in a calendar month. This service includes real-time audio and video communication between the patient and the healthcare professional, as well as remote evaluation of pre-recorded patient information.
- CPT code 99458: This code is used for additional remote evaluation and management services provided by a physician or other qualified healthcare professional, beyond the initial 20 minutes of clinical staff time in a calendar month. This service includes an additional 20 minutes of clinical staff time.
- CPT code 99454: This code is used for remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry) for up to 30 days, provided to an established patient with a chronic condition. This service includes the set-up and patient education on the use of the remote monitoring equipment.
- CPT code 99458: This code is used for additional remote monitoring of physiologic parameter(s) beyond the initial 30 days, provided to an established patient with a chronic condition. This service includes the review of the data and any necessary adjustments to the care plan.
Medicare Criteria for RPM Pain Management Billing
Medicare provides reimbursement for RPM services, including those related to pain management, as long as certain conditions are met. Here are the steps to follow to bill Medicare for RPM in pain management:
- Meet Medicare’s RPM requirements: Medicare has specific requirements for RPM services, including that the service must be ordered by a physician or other qualified healthcare professional, and that the patient must consent to the service. Additionally, the patient must have a chronic condition that requires regular monitoring, such as chronic pain.
- Choose an RPM device: There are many different RPM devices available, so it’s important to choose one that is appropriate for pain management. Some examples include devices that track activity levels, sleep patterns, or pain levels.
- Set up the RPM device: Once you have chosen an RPM device, you will need to set it up and provide instructions to the patient on how to use it. This may involve training the patient on how to take readings or use the device.
- Collect data from the RPM device: The RPM device will collect data on the patient’s condition, which can be transmitted to the healthcare provider for review. The provider should review the data regularly and adjust the patient’s treatment plan as needed.
- Document the RPM service: As with any medical service, it’s important to document the RPM service in the patient’s medical record. This should include information on the device used, the data collected, and any changes to the patient’s treatment plan.
- Use appropriate CPT codes: To bill Medicare, you will need to use the appropriate procedure codes for RPM in pain management. The specific codes you use will depend on the type of service provided and the amount of time spent on the service. Medicare identifies above mentioned procedure codes for RPM in pain management.
By following the steps above, providers can ensure that they are meeting Medicare’s requirements and receiving reimbursement for RPM services.
Hope that this article has provided you enough information on procedure codes for RPM in pain management. Legion Healthcare Solutions is a leading medical billing company providing complete billing and coding services. Our expert pain management coders and billers are well aware of payment guidelines for various insurance companies. With our comprehensive pain management billing and coding services, we can assist you in receiving insurance reimbursements for delivered services. To know more about our pain management billing services, contact us at 727-475-1834 or email us at email@example.com